MRI: Is gadolinium safe for people with kidney problems?

I need to have an MRI, but I have kidney problems. Can an MRI hurt my kidneys?

Answer From Fouad Chebib, M.D.

It depends on the type of magnetic resonance imaging (MRI) scan you have. An MRI can be done with contrast or without contrast. An MRI done without contrast causes no special concerns for people with kidney problems.

An MRI with contrast uses contrast agents to enhance the MRI scan. Contrast agents are injected into a vein in the hand or arm. The contrast agents used for MRI scans often contain a chemical element called gadolinium (gad-oh-LIN-e-um).

Newer contrast agents that contain gadolinium are generally safe for people with kidney disease, even those who receive dialysis. But that might not be the case with older contrast agents. The type of gadolinium used in older contrast agents isn’t safe for people with moderate or advanced chronic kidney disease.

Older versions of contrast agents that contain gadolinium increase the risk of a rare but serious disease called nephrogenic systemic fibrosis. This disease triggers thickening of the skin, organs and other tissues. In some cases, it can cause death.

The discovery of this rare disease led to the development of newer, safer versions of gadolinium contrast agents. But a small risk still remains.

Before you have an MRI, make sure your health care provider knows about your kidney problems. Blood tests can show how well your kidneys work. This can help determine your risk of nephrogenic systemic fibrosis.

If you receive dialysis, your care provider may advise that you have dialysis right after the MRI. Dialysis is a procedure that uses a machine to filter and remove waste from the blood. This helps your body get rid of the contrast agent after the MRI. It also may lessen the risk of harm to your kidneys.

If you need to have an MRI with an older gadolinium contrast agent, your provider may want you to have dialysis once a day for up to three days after the scan. This may lower the risk of nephrogenic systemic fibrosis. Talk with your kidney care team about the best approach in your case.